MEDICARE: CHARLES A. CASARONA, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	16252	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811014293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES A. CASARONA, MD

Provider Business Mailing Address
First Line	:	4900 20TH AVE
Second Line	:
City	:	VALLEY
State	:	AL
Zip	:	36854-3549
Country	:	US
Telephone Number	:	334-756-5137
Fax Number	:	334-756-6523

Provider Business Practice Location Address
First Line	:	4900 20TH AVE
Second Line	:
City	:	VALLEY
State	:	AL
Zip	:	36854-3549
Country	:	US
Telephone Number	:	334-756-5137
Fax Number	:	334-756-6523

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. CHARLES A CASARONA
Credential	:	M.D.
Telephone Number	:	334-756-5137

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/20/2008

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